Hamstring injury mini-symposium (BJSM papers that will help you manage hamstring injuries).

Bruce Hamilton’s article (Hamstring muscle strain injuries: what can we learn from history? 2012;46: 900-903) is receiving a lot of attention. Current in this month’s BJSM print edition, >6,000 people have already downloaded and digested it (free full text!). This October issue has been shaped by the Australasian College of Sports Physicians, one of BJSM’s 8 member societies (and more to be announced shortly!).

Clinicians’ interest in hamstring injury prevention, diagnosis, and management is no surprise. Elite athletes from American Football (i.e Jets’ tight end Dustin Keller who has missed four weeks – to date – with a hamstring injury), to European Football (i.e Manchester City’s Jack Rodwell who may be warming the bench for England in Tuesday’s Euro 2013 decider) suffer from hamstring injury. Rodwell has the classic ‘recurrence’ issue – six such injuries this season.

As a ‘mini-symposium’ we share 4 recent papers below. Their take-home messages include that: (i) focussed eccentric loading – in the appropriate functional range of motion is critical, (ii) that there are different types of hamstring strains with different prognosis (Type 1 ‘sprinters’; Type 2 ‘dancers’), (iii) there remains an element of art in treatment – but don’t give up the science as the first option. And don’t forget Carl Askling’s podcast – one of BJSM’s most popular of all time.

BJSM senior associate editor Roald Bahr (@RoaldBahr) vouches strongly for the ‘nordic hamstring’ exercises to prevent recurrence. He suggest that EPL teams should be ensuring the high-risk players (those with previous injury) perform the program. You can see the video of this program at the Oslo Sports Trauma Research linked web-page. (Skadefri which means ‘Injury Free’). The words are in Norwegian but the images speak for themselves. And while you are on that site check out the IOC Manual of Sports Injuries – great value and completely up to date.

In short – no-one has all the answers but progressive and functional training – with a particular focus on players who have already had a hamstring strain – is a way to go. Please do share your solutions confidentially or in public.

Related publications

Mendiguchia J, Alentorn-Geli E,Brughelli M. Hamstring strain injuries: are we heading in the right direction? Br J Sports Med 2012;46:81–5.

Askling CM, Malliaropoulos N, Karlsson J. High-speed running type or stretching-type of hamstring injuries makes a difference to treatment and prognosis Br J Sports Med 2012;46:2 86-87 Published Online First: 14 December 2011

Orchard JW, Best TM, Mueller-Wohlfahrt HW, et al The early management of muscle strains in the elite athlete: best practice in a world with a limited evidence basis. Br J Sports Med 2008;42:158–9. (Free full text)

Askling CM, Tengvar M, Saartok T, et al. Acute first-time hamstring strains during high-speed running: a longitudinal study including clinical and magnetic resonance imaging findings. Am J Sports Med 2007;35:197–206.

 Askling C, Saartok T, Thorstensson A. Type of acute hamstring strain affects flexibility, strength, and time to return to pre-injury level. Br J Sports Med 2006; 40: 40-4. 


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